America needs to keep the door open to immigrant physicians

he path to a career in medicine in the United States is long and arduous. That is especially and literally true for immigrants. But it’s worth it for them — and for the health of all Americans.

There are several pathways by which immigrant physicians can practice in the US, all of which come with serious challenges.

Those who receive medical degrees elsewhere — often called international medical graduates — face obstacles ranging from visa limitations and additional tuition costs to physical relocation and its myriad accompanying social and cultural implications. Foreign medical licenses often don’t transfer to the US, requiring physicians to spend up to $15,000 over a three-to-five-year period for duplicative training. Resource constraints force some foreign-trained physicians to alter their career paths to become nurses or physician assistants in the US.

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For foreign-born students fortunate enough to gain admittance to a US medical school and earn their medical degrees here, the sacrifice of time spent away from family can be enormous.

We use the term immigrant physician to encompass individuals who earn their medical degrees outside of the US, foreign born students who get their MDs in a US school, and individuals of immigrant backgrounds who earn their MDs here, like us.

Despite the challenges, many immigrant physicians have found ways to persevere and make profound contributions to the US health care system. According to the Association of American Medical Colleges, international medical graduates currently account for nearly 25 percent of all practicing US physicians (including residents and fellows), 16 percent of all health care occupations, and a whopping 51 percent of medical scientists. The numbers are even higher if you include US medical graduates from immigrant backgrounds.

The Institute for Immigration Research has shown that many immigrant physicians go on to become inspiring leaders in biomedicine, ranging from deans of medical schools to neurosurgeons and Nobel laureates in science, admired for their hard work, talent, and dedication to service.

Yet the current meritocratic culture of inclusiveness may be facing a serious threat. The recent election season in the US featured ethnocentric rhetoric and proposals that challenge the integration of immigrant physicians into the US health care system. Established immigrant physicians, especially those of the Muslim faith, have expressed concern about the recent wave of anti-Muslim sentiment, which may result in extreme vetting, forced registry, or a complete ban on entry to the US. Others worry about deportation.

Another roadblock to immigrant physicians is the potential dissolution of President Obama’s Deferred Action for Childhood Arrivals program (DACA), something that President Trump pledged to undo upon being elected. It aimed to give nearly a million undocumented immigrants who came to this country as children the right to pursue higher education and contribute to the US workforce. Under it, over 160 undocumented immigrants applied to medical school to date. While the Department of Homeland Security says the program will stay open for the time being, the futures of currently enrolled and future-hopeful DACA medical students remains uncertain under the new administration.

We believe that immigrant physicians should be valued as tremendous assets to the American health care system. Immigrant students and workers are prone to academic and economic success in the US, having been instilled with the values of education, hard work, and high aspirations at young ages. The resilience that immigrants build during drastic transition periods is directly applicable to high-stress learning and working environments, such as clinical rotations in medical school, residency, and beyond.

By 2044, more than half of the US population will be individuals of color, making this a “plurality” nation. Health care practitioners will need to become more adept at what’s called cultural brokerage to understand and deliver culturally sensitive care. Studies have consistently demonstrated the importance of sharing cultural and racial norms and language with improved health care access, utilization, quality, and outcomes.

Having been raised in varied cultures and communities, immigrant physicians tend to be adaptable, able to balance rugged individualism with community-mindedness, tempering medical expertise with open-mindedness to unconventional approaches, and augmenting autonomy with reliance on others in times of need. With such skills, immigrant practitioners can serve as leaders in improving the standard of care for a wide range of racial and ethnic backgrounds in a country that will only continue to increase in diversity.

No matter what happens to the Affordable Care Act under a Trump administration, the health of the American people will depend on having enough talented and devoted physicians as possible — regardless of their backgrounds. Nearly half of immigrant physicians pursue internal medicine or other general specialties, compared to 15 percent of US medical graduates. They are also more likely to practice in rural and inner-city areas. Rural states such as Wyoming and North Dakota already depend on immigrant physicians, who comprise the majority of their physician workforces.

Medicine should be an inclusive endeavor. Now is a good time for all medical professionals to reaffirm our culture of inclusiveness and embrace immigrant physicians. They have much to offer Americans, and America has much to offer them. But perhaps more important than any meritocratic or economic argument is the intrinsic value of inclusion in medicine, to do no harm toward and to extend healing to all.

Numerous institutions and cities have declared their domains as sanctuaries or safe havens for immigrants, places where they can learn or live without harassment or the looming threat of deportation. We believe that medicine should uphold the same principle as a profession. Immigrant physicians represent a huge asset for the medical profession, and will be an important part of the health care system for generations to come. Attracting and training these future physicians will be a boon for public health.

Jason J. Han is a fourth-year medical student at the University of Pennsylvania Perelman School of Medicine. Neha Vapiwala, MD, is associate professor of radiation oncology and advisory dean at the Perelman School of Medicine.

We’ll see if Americans are gullible enough to believe that we cannot produce our own physicians for our health care system. Let me guess, we’re too stupid and the only place to find people smart enough is India, right?

“Having been raised in varied cultures and communities, immigrant physicians tend to be adaptable, able to balance rugged individualism with community-mindedness, tempering medical expertise with open-mindedness to unconventional approaches, and augmenting autonomy with reliance on others in times of need. ”

SOME immigrant doctors are great. Some are not. I bet you have no stats to back up your claims.

Take a look at the stats from the UK’s disciplinary body for physicians, and from the canadian equivalent.

Very clear trends showing that the bulk of sexual assault by physicians and the bulk of claims for incompetence involve immigrant doctors, particularly of Pakistani, Kashmiri, Indian, Arab and African descent.

I agree with much of what the authors say. The fact is that there are many areas of the country which are underserved and which are likely to remain that way without access to international medical graduates. Domestic graduates often choose markets that are more appealing for lifestyle reasons, which leads to oversaturation of areas like Boston and New York, and insufficient service of areas like New Mexico, the Dakotas, and rural southern areas. I think we need to drop the jingoistic nationalism that says “We’re fine without help” because we’re not. International medical graduates are trained differently, but often those differences can be beneficial. The assumption of superior competence made by American trained doctors like myself is a dangerous example of hubris and complacency. Do we need to generate more domestic graduates? Absolutely. Do we need to make med school free for all who pass a certain merit standard? Yes. But turning away from international graduates will have immediate ramifications for many regions.

The one aspect of the article I’d quibble with is the implication that immigrant physicians are somehow “more deserving” than other immigrants. As a physician, one important lesson I’ve learned is that we cannot see ourself as greater or “worth more” than the average person because that assumption dehumanizes us, and makes us less compassionate and proficient as doctors.

I disagree strongly! And I question rather this article is in fact written by IMG??

We have excellent US train doc’s and should leverage the providers we already have in place. Yes we need more providers, but MD, DO, PA, and NPs are filling these roles and in the past 5-10 years the number of programs and graduates has gone up tremendously.

I have worked in a hospital system with many IMG – and the difference in the quality of education, and their ability to relate to the American culture and society seem to be truly lacking – continually…..

We need to “grow our own” and stop stealing from other countries!

In most countries medical school is paid for/supported to large degree by the countries and states – to continually siphon off their own physicians we are brain draining their countries. Instead lets grow our own education programs to meet our own needs.

To many times I have had to go back into a room and explain what is going on because the IMG was not understandable, did not pick up on cultural ques or just flat out didn’t care….

I vote for increased restrictions on IMG and training more of our own – heck with utilizing PA and NP (The VA just made NP’s independent providers nationwide, an PAs are also amazing providers) along with the recent dramatic increases in medical school programs we have more than enough medical talent.

If the country is really serious about fixing the physician shortage – allow PAs to develop a bridge – 1 year medical college, and abbreviated residency to fill in all the PCP shortages – no that is a solution!!!